disulfiram

Adjunctive therapy

Brands: Antabuse

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

View details

Quick answers

What is disulfiram?
Disulfiram (brand Antabuse; generics) is an aversive-therapy medication for alcohol use disorder (AUD). It works by inhibiting aldehyde dehydrogenase, so drinking alcohol can trigger an unpleasant (and potentially dangerous) acetaldehyde reaction (label/guideline).
What is Antabuse?
Antabuse is a brand name for disulfiram.
What is Antabuse (disulfiram) used for?
Label indications include: Adjunct in the management of chronic alcohol use disorder (aversion therapy) (label).
What drug class is Antabuse (disulfiram)?
Aldehyde dehydrogenase inhibitor used as aversive therapy for alcohol use disorder; can cause a severe and prolonged reaction if alcohol is consumed (label/guideline).
What strengths does Antabuse (disulfiram) come in?
Oral tablets (label): 250 mg, 500 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: Antabuse
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-30

Label indications

Adjunct in the management of chronic alcohol use disorder (aversion therapy) (label).

View labelExact

Clinical Highlights

Disulfiram (brand Antabuse; generics) is an aversive-therapy medication for alcohol use disorder (AUD). It works by inhibiting aldehyde dehydrogenase, so drinking alcohol can trigger an unpleasant (and potentially dangerous) acetaldehyde reaction (label/guideline). Because the effectiveness of disulfiram depends heavily on whether it is taken, outcomes are best when dosing is supervised or strongly supported (family support, observed dosing programs) and when the goal is abstinence rather than drinking reduction (guideline/clinical).

Alcohol exposure can be unintentional (cough syrups, mouthwashes, cooking extracts, “non-alcoholic” beverages, topical products). Clinical counseling often focuses on hidden alcohol sources and on having an emergency plan if symptoms occur (label/clinical).
Disulfiram is not used for acute alcohol withdrawal. Withdrawal is managed separately; disulfiram is discussed later as a relapse-prevention option for selected patients (guideline/clinical).
Liver toxicity and neurologic adverse effects are important safety concerns; baseline medical review and follow-up labs are commonly used when disulfiram is prescribed (label/clinical).
The compare view, disulfiram evidence feed, and disulfiram print page support shared decision-making when abstinence-focused alcohol treatment is being weighed against side effects and practical safety constraints.

Dosing & Formulations

Oral tablets (label): 250 mg, 500 mg. Disulfiram is typically taken once daily. Many programs emphasize consistency and supervised dosing where feasible because missed doses reduce the intended aversive effect (label/clinical).

Label guidance includes an alcohol-free interval before initiation and continued alcohol avoidance for up to 14 days after stopping because the reaction risk can persist (label).

Monitoring & Risks

Alcohol-disulfiram reaction: flushing, nausea/vomiting, hypotension, chest discomfort, and more severe cardiovascular or neurologic symptoms can occur depending on alcohol dose and medical risk factors (label). Hepatotoxicity: labeling includes warnings about hepatitis and liver failure. Baseline and follow-up liver function monitoring is commonly used, especially early in treatment (label/clinical).

Neuropsychiatric and neurologic effects (fatigue, headache, neuropathy, mood symptoms) can occur; clinicians often reassess risk-benefit if symptoms emerge (label/clinical).
Disulfiram is generally avoided in people with severe cardiac disease or acute psychosis and is used cautiously when cognition is impaired, because unintentional alcohol exposure can be risky (label/clinical).

Drug Interactions

Alcohol-containing products are the key interaction risk and include OTC medications and some topical products; clinicians often provide a “hidden alcohol” list (label/clinical). Disulfiram can interact with several medications (including metronidazole and some anticoagulants), so medication reconciliation is a routine part of prescribing (label).

Practice Notes

Guidelines often reserve disulfiram for selected patients when abstinence is the goal and when supervision or strong adherence support is feasible; naltrexone or acamprosate are more commonly first-line options (guideline/clinical). Because alcohol use disorder (AUD) often overlaps with insomnia, anxiety, and depression, disulfiram decisions are commonly paired with symptom management planning and relapse-risk follow-up (clinical).

References

Disulfiram tablets prescribing information — DailyMed (2025)
Pharmacotherapy FOR Adults With Alcohol USE Disorders IN Outpatient Settings: A Systematic Review AND Meta Analysis — JAMA (2014)
The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder — American Journal of Psychiatry (2018)
Anticraving therapy for alcohol use disorder: A clinical review — Neuropsychopharmacology Reports (2018)